Sports Medicine Research: In the Lab & In the Field: Is Scapular Dyskinesis A Risk Factor or An Early Warning for Shoulder Injury? (Sports Med Res)
Monday, September 25, 2017

Is Scapular Dyskinesis A Risk Factor or An Early Warning for Shoulder Injury?

Scapular Dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis

Hickey D, Solvig V, Cavalheri V, Harrold M, Mckenna L . Br J Sport Med. 2017; ahead of print.

Take Home Message: Athletes with scapular dyskinesis have a 43% greater risk of developing shoulder pain compared with athletes without scapular dyskinesis.

One potential risk for shoulder pain is scapular dyskinesis, (altered position and/or motion of the scapula). Scapula dyskinesis is thought to place abnormal forces and disrupt the overall function of the glenohumeral joint, thereby increasing the risk of shoulder pain and impairments. Interesting scapular dyskinesis is often observed in both symptomatic and asymptomatic athletes. Therefore, it remains unclear whether the presence of scapular dyskinesis increases the risk of developing shoulder pain in asymptomatic athletes. To help investigate this question the authors conducted a systematic review to identify whether the presence of scapular dyskinesis in asymptomatic athletes increase the risk of developing future shoulder pain. Following PRIMSA guidelines, the authors performed the search in 6 databases: Cochran Library, EMBASE, PubMed, CINAHL, SPORTDiscus. Inclusion criteria comprised prospective studies within an athletic population that identified whether these athletes were assessed for scapular dyskinesis, pain free at baseline, and were assessed for pain at follow-up. The authors identified 5 articles that met the inclusionary criteria. Quality of these articles were assessed using a modified version of the Downs and Black guidelines, where the max score was 20 instead of 30. Based on this modified scale the average score was 16/20 (81%). Out of 419 athletes, 160 (38%) presented with asymptomatic scapular dyskinesis. Over a period of 9 to 24 months 56 (35%) athletes with scapular dyskinesis developed shoulder pain. In comparison 65 of the 259 athletes (25%) without scapular dyskinesis developed shoulder pain. The authors found that the presences of scapular dyskinesis at baseline was indicative of a 43% increased risk of shoulder pain over a 9 to 24 month follow up.

The authors found that athletes with scapular dyskinesis have a greater chance of developing shoulder pain compared to athletes who did not have scapular dyskinesis. In this current review 65% of the athletes had shoulder pain, and only 25% did not have scapular dyskinesis. One important note to keep in mind is that not all the athletes included were overhead athletes (70 rugby players). Therefore, these athletes may not be at the same risk as an overhand athlete. It is also critical to further evaluate the 160 athletes with scapular dyskinesis. Only 56 of the athletes with scapular dyskinesis developed a painful shoulder; therefore, the remaining 65% of those athletes remained asymptomatic over a long period of time. Therefore, it remains inconclusive if scapular dyskinesis contributes to the development of shoulder pain in athletes. Based on the results of the study there is not a clear answer if scapular dyskinesis is a risk factor for shoulder pain. Additional high-quality research studies are required to add to the body of knowledge and to further understand the role of scapular dyskinesis in the development of shoulder pain in athletes. The authors also suggested that screening for several risk factors of shoulder pain (range of motion, rotator cuff strength) including scapular dyskinesis would be better than screening for scapular dyskinesis alone.

Questions for Discussion: Have you seen scapular dyskinesis as a risk factor for shoulder injury in your clinical practice? Do you screen for scapular dyskinesis in your overhead throwing athletes?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban & Steven Thomas

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